Strategies to engage and retain pregnant individuals and young mothers in the nurse-family partnership program (Canada): An interpretive descriptive study

BACKGROUND: The issue of client retention has long been a challenge for home visitation programs, including Nurse-Family Partnership (NFP). OBJECTIVE: To describe 1) how Canadian public health nurses and supervisors supported the engagement and retention of clients enrolled in the NFP program and 2) factors that influenced client retention. PARTICIPANTS AND SETTING: Nurses (n = 79) and supervisors (n = 15) from five regional health authorities delivering NFP as part of the British Columbia Healthy Connections randomized controlled trial and longitudinal process evaluation studies (Canada). METHODS: The principles of interpretive description guided study decisions. Data for this analysis were extracted from three (of eight) waves of in-depth interviews across a four year-period (2014-2018). A total of 63 transcripts (n = 15 nurse focus group transcripts; n = 15 one-to-one nurse interview transcripts; n = 33 supervisor interview transcripts) were coded and analyzed. RESULTS: Nurses and supervisors perceived client engagement and retention to be maximized when NFP was well connected to the community and flexibly delivered by consistent nurses who individualized the program to the needs of clients over the duration of this intervention. Multiple intersecting program, nurse, client, and social/environment-related factors were reported to influence engagement and retention. CONCLUSIONS: Sustained engagement of clients in NFP is promoted when community partners make appropriate referrals, NFP agencies implement nurse retention measures, and nurses apply the principles of trauma-and violence-informed care to their relational work with clients.